| NPI | 1154315745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: AZ 25603) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: AZ 25603) |
| 207Q00000X Family Medicine (Licence: AZ 25603) | |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2023-03-06 |